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2023 Caregiver's Survey
Thank you so much for being a part of the Caregiver's Respite community. Help us get to know your situation better by telling us what you enjoyed and what we can do better for future programs.
* Indicates required question
Name
*
Your answer
Email
Your answer
Phone
Your answer
Zip Code
*
Your answer
Age
*
18-30
31-40
41-50
51-60
61-70
71-80
81-90
over 90
under 18
Rate your own overall health
5 - Excellent
4 - Good
3 - Average
2 - Poor
1 - Terrible
Physical Health
Mental Health
Spiritual Health
5 - Excellent
4 - Good
3 - Average
2 - Poor
1 - Terrible
Physical Health
Mental Health
Spiritual Health
Clear selection
Do you work from home?
Yes
No
Hybrid (home and office)
Other:
Clear selection
Do you feel like your employer is flexible / accommodating when it comes to your caregiver duties?
Your answer
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